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Patient Assistance Information

 
Program Sponsored By Daiichi Sankyo (External Link)
 
 
Daiichi Sankyo Open Care Program

PO Box 8409
Somerville, NJ 08876
Phone : 866-268-7327 Ext 1
Fax: Not Applicable
Eligibility
> This program is intended for patients that are uninsured. Medicare Part D patients are not eligible for this program. Patient's income must be at or below 200% FPL. Must be citizen or legal resident.
Who Can Apply
> The physician's office must call for application, which will be faxed. Application can be returned via fax or mail. Patient will be notified of denial in writing.
Required
> Doctor must complete section, sign, attach required documents. Patient must complete section, sign, attach a copy of proof of income.
Supply
> Up to 90 day supply. Patient or Doctor must contact company for refills. Refill limit not specified. New application and documentation is required yearly.
Ship To
> Medication is sent to Doctor's office within 2 weeks.
Note
> No online application available.
 
Includes Support for This Drug
NOTE: Linked drugs are available for Prescribers to Apply Online now.
Click drug logo or drug name to start online application.
 
Azor tablet
Benicar HCT Tablets
Benicar Tablets
Savaysa tablet
Tribenzor tablet
Welchol oral suspension
Welchol tablet